Long term success for endodontic surgery is quoted to range from as low as 20+% to as high as over 90%. The weighted average of the success of endodontic surgery can said to be in the 70% range. However, if retreatment precedes endodontic surgery then the success of periapical surgery improves significantly. In day to day endodontic practice, the decision to perform a retreatment or periapical surgery or both is a difficult one to make.
Retreatment alone shall be the first option for most failing endodontic treatments. However a few times periapical surgery may turn out to be a more practical solution. Patients shall be informed of all the options and the pros and cons of doing surgery alone.
For example, in the attached case, tooth #8 is failing subsequent to a root canal TX, cast post and core. To attempt a retreament involves disassembly of the restoration which may result in the loss of the very little coronal tooth structure remaining. Root fracture during the post removal process is a possibility as well. Doing surgery alone may result in a late failure if there is coronal leakage. I discussed with the patient all the pros an cons of retreatment/surgery and we both decided to go ahead with Surgery.
A Luebke-Oschenbein style full thickness flap was raised, osteotomy was done on the buccal. Lesion was found eroding the palatal bone, making this a through and through defect. Curettage, root end resection followed by root end filling with MTA were performed under the surgical operating microscope.
Flap was sutured with 4-0 monofilament sutures. Sutures were removed in 4 days with uneventful healing.Patient will be recalled periodically to review the bony healing.
